Birth Doula Service Agreement

This contract, by and between DoLove Birth Services and
labor doula, Lucretia Jones, herein referred to as the
doula, and _________________________________, herein referred to as the client,
agree to the following terms:

Services To Be Provided:

Upon signing of this contract, the doula shall meet with the
client at least once prior to labor, provide client with phone numbers and
email so the doula may be reached in between appointments and 24 hours a day
during the on call period, assist the client with making plans for the birth
and writing a birth plan, and provide referrals for other services in the
community. The doula will be on-call for a period of two weeks before to two
weeks after the estimated due date. Once called upon in labor, the doula shall
arrive within two hours of that call and will stay with the client
until one to two hours after the birth, unless otherwise indicated by the
client. The doula will also provide at least one postpartum visit which
includes _____________.

Doula’s Responsibilities:

It is the responsibility of the doula to inform the client
of any dates or times she will be unavailable for service and she shall arrange
for a backup doula for those dates or times. The doula shall pay an arranged
backup doula for any services rendered per the agreement between them. The
doula shall provide physical, emotional, and informational support for
pregnancy, labor and birth. The doula shall NOT perform any clinical
assessments (including vaginal exams, fetal heart tones, or taking vital signs,
blood pressure checks). The doula shall NOT speak on behalf of the
client or make any decisions for the client.

Client’s Responsibilities:

The client is responsible for her clinical and medical
well being. The client is responsible for informing her caregiver that a doula
will be present at her birth and assuring that the doula will be allowed to
serve her. The client is responsible for making informed decisions, by
educating herself through self-study, completion of homework and questionnaires
provided by the doula, and childbirth classes. The client will notify the doula
of any pregnancy or non-pregnancy complications when they arise. When the
client is in labor, she shall inform the doula as early as possible to afford
the doula time to make any personal arrangements.

Long Labors:

If you have an extended labor (lasting more than 20 hours),
and the doula feels she is unable to support you appropriately due to exhaustion,
the doula reserves the right to call in a backup doula to come be with you for
the remainder of your labor or for a period of time that will allow her to get
adequate rest. You have the right to decline the backup doula, but there will
be no reduction in fees.

Cesarean Births:

If client has a cesarean section, planned or emergency, all
fees remain the same. The doula will stay and offer as much support as the
medical staff will allow. It is up to client to secure the doula’s place in the
operating room. If it is a scheduled cesarean, the doula will meet you at the
hospital at your scheduled time. The doula will accompany client in the
operating room (if allowed by medical staff) and remain with client during
recovery, and offer emotional support and breastfeeding support after the
birth. If for some reason the doula is not allowed to be present in the
operating room (emergency, policy, etc.) she will join you after the birth so that client will not be
left alone for the rest of the surgery. If breastfeeding is delayed more than 4
hours due to complications, the doula will return at an appropriate time to
assist the client with breastfeeding and newborn care issues.

Failure of Doula to Provide Services:

The doula will make every effort to provide the services
described herein. Sometimes this is impossible due to factors beyond our
control. If a failure to attend your birth is an error of the doula, nothing
else will be owed by client or client will be refunded all fees paid less the
non-refundable deposit of $100 paid at contract signing. If failure to attend
your birth is not an error of the doula, such as precipitous labor, failure of
the client to call or notify the doula, or natural disaster, the contract
stands as is. In the case of precipitous labor or failure to notify the doula,
the doula can join the client after birth. The doula will remain with the
client for the normal period of time to help her get settled in and establish
breastfeeding just as the doula would have if present during the actual birth.
The doula will also provide the postpartum visit service per this agreement.

Back-up Services:

Sometimes illnesses and family emergencies happen. These
situations are not considered by either party a failure of the doula to provide
services. If the doula is unable to attend your birth, she will contact one of
her backups. You have the right to decline the backup, but there will be no
reduction in fees.

Optional Photography:

The doula may take photographs at births to document your
amazing birth experience as well as to use for marketing purposes. It is up to
you if you chose to allow any photography during your labor or birth process.
Any and all photographs taken during your labor and birth will be copied to a
disc and given to you for your personal use as well. Photographs containing
nipples or genitalia will not be published without your separate and specific
consent.

____I/We agree to allow photography during our labor.

___I/We do NOT agree to allow photography during our labor.

Fees:

The fee for labor doula services is $200-400. $100 is due
upon contract signing and is non-refundable. The remaining balance ($100- 300)
is due prior to the beginning of “on-call” time two weeks before your due date.
Payment schedules or special circumstances may be arranged but must be agreed
upon by all parties for this contract to be valid. The doula will not attend a birth
for which she has not received full payment. The only exception is if baby is
born prior to 38 weeks. In this situation, payment is due in full within 5 days
of birth.

Returned Checks:

If you make a payment by check, and it is returned by your
bank for any reason, a $25 processing fee will apply and full payment in the
form of cash only will be due immediately. Failure to pay the full fee in cash
within 3 days of notification of your check being returned will result in
cancellation of this contract and any monies already paid will be forfeited.

Certification Births:

Since the doula is currently working on her toLabor Labor
Doula Certification, she is offering reduced fees in exchange for the clients
help in obtaining certification. This will require you, your doctor/midwife,
and your labor nurse to fill out paperwork evaluating the doula's services. If
you choose to participate in this evaluation process, the doula will refund you
$100 upon the acceptance of your birth as counting towards the doula's
certification by toLabor. If, for any reason, your birth is not usable towards
certification (precipitous birth, missing paperwork, etc.), then no refund will
be given.

_____Please check this line if you choose to participate in the toLabor certification evaluation process.

We, the undersigned, agree to the terms and conditions
stated above and we fully understand the responsibilities of the doula as well
as our own.